A Practical Manual of Diabetes in Pregnancy (McCance/A Practical Manual of Diabetes in Pregnancy) || Hypertension in Diabetes in Pregnancy

✍ Scribed by McCance, David R.; Maresh, Michael; Sacks, David A.

• Publisher: Wiley-Blackwell
• Year: 2010
• Weight: 514 KB
• Edition: 1
• Category: Article
• ISBN: 140517904X
• DOI: 10.1002/9781444315196.ch15

✦ Synopsis

A 28 -year -old woman with a 23 -year history of Type 1 diabetes and a 2 -year history of diabetic nephropathy presented in her fi rst pregnancy. BP (114/75 mmHg) and serum creatinine were normal, but urinary albumin excretion was elevated at 941 mg/24 h on an ACE inhibitor and diuretic treatment. She was treated with a conservative antihypertensive strategy as follows: at the fi rst pregnancy visit at 10 weeks of gestation she was changed from the ACE inhibitor to methyldopa 250 mg twice daily, while diuretic treatment with furosemide 40 mg twice daily was continued. When BP exceeded 140/90 mmHg at 29 weeks, methyldopa was gradually increased to 500 mg four times daily. Unfortunately, she progressed to pre -eclampsia with severe hypertension and proteinuria and was delivered at 32 weeks. The baby ' s birthweight was 1800 g.

A few years later she was again pregnant. The serum creatinine level had increased to 120 μ mol/L (1.36 mg/ dL) and the urinary albumin excretion to 3000 mg/24 h, with BP 108/68 mmHg controlled with ACE inhibition and diuretics. Again ACE inhibition was stopped, but in this pregnancy she was treated with an aggressive antihypertensive strategy and by 16 weeks of gestation was on the maximum dose of methyldopa, unchanged diuretics, and labetalol treatment was initiated and gradually increased to maximum dose. She continued to excrete nephrotic range proteinuria but BP remained below 130/80 mm/Hg. At 36 weeks she had no symptoms of pre -eclampsia but was delivered due to an increasing serum creatinine level. The baby ' s birthweight was 2584 g.